Provider Demographics
NPI:1003909961
Name:WARREN, TERRI J (ANP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:J
Last Name:WARREN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:G
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:2330 NW FLANDERS ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3442
Mailing Address - Country:US
Mailing Address - Phone:503-226-6678
Mailing Address - Fax:503-226-4307
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-226-6678
Practice Address - Fax:503-226-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR082011212N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMW0135409OtherDEA
ORP15835Medicare UPIN